Amy Kule1, Bophal Hang1, Amit Bahl1. 1. Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan.
Abstract
BACKGROUND: Venous access can occasionally be difficult to obtain secondary to near-complete compressibility of peripheral veins in some patients. OBJECTIVE: This study utilizes ultrasound to assess vein compressibility with different tourniquet techniques commonly available in the emergency department. METHODS: After approval by the Institutional Review Board, a prospective single-center study was conducted assessing the compressibility of basilic veins with ultrasound. Compressibility was assessed at baseline, use of one proximal tourniquet, two tourniquets (one distal and one proximal), and a proximal blood pressure cuff inflated to 150 mm Hg. Vein compressibility was rated as complete, moderate, or mild after light pressure was applied with the ultrasound probe. RESULTS: One hundred healthy patients were recruited into the study. Ninety-eight subjects had completely compressible basilic veins at baseline. When one tourniquet and two tourniquets were applied, 62 and 31 participants, respectively, demonstrated completely compressible veins. Fisher's exact test comparing one vs. two tourniquets revealed no difference between these two techniques (p = 0.4614). Only two participants continued to have a completely compressible vein after application of the blood pressure cuff with statistical significance by Fisher's exact test compared to both tourniquet groups (p < 0.0001). CONCLUSIONS: Both tourniquets and blood pressure cuffs can decrease the compressibility of peripheral veins. Although no difference was identified between one and two tourniquets, utilization of blood pressure cuffs significantly decreased compressibility. The findings of this study can be utilized in the emergency department when attempting to obtain peripheral venous access, specifically supporting the use of blood pressure cuffs to decrease compressibility.
BACKGROUND: Venous access can occasionally be difficult to obtain secondary to near-complete compressibility of peripheral veins in some patients. OBJECTIVE: This study utilizes ultrasound to assess vein compressibility with different tourniquet techniques commonly available in the emergency department. METHODS: After approval by the Institutional Review Board, a prospective single-center study was conducted assessing the compressibility of basilic veins with ultrasound. Compressibility was assessed at baseline, use of one proximal tourniquet, two tourniquets (one distal and one proximal), and a proximal blood pressure cuff inflated to 150 mm Hg. Vein compressibility was rated as complete, moderate, or mild after light pressure was applied with the ultrasound probe. RESULTS: One hundred healthy patients were recruited into the study. Ninety-eight subjects had completely compressible basilic veins at baseline. When one tourniquet and two tourniquets were applied, 62 and 31 participants, respectively, demonstrated completely compressible veins. Fisher's exact test comparing one vs. two tourniquets revealed no difference between these two techniques (p = 0.4614). Only two participants continued to have a completely compressible vein after application of the blood pressure cuff with statistical significance by Fisher's exact test compared to both tourniquet groups (p < 0.0001). CONCLUSIONS: Both tourniquets and blood pressure cuffs can decrease the compressibility of peripheral veins. Although no difference was identified between one and two tourniquets, utilization of blood pressure cuffs significantly decreased compressibility. The findings of this study can be utilized in the emergency department when attempting to obtain peripheral venous access, specifically supporting the use of blood pressure cuffs to decrease compressibility.
Authors: Fredericus H J van Loon; Lisette A P M Puijn; Saskia Houterman; Arthur R A Bouwman Journal: Medicine (Baltimore) Date: 2016-04 Impact factor: 1.889